Massachusetts Appellate Court Reverses Denial of Coverage for Continued Medical Treatment in Left Shoulder Injury Case

When you suffer an injury on the job, you may be able to recover and return to a normal functioning level. This can be a contentious issue in cases, especially when you argue that you still need medical treatment, but the insurer argues that you have reached maximum medical improvement. When complex medical conditions are involved, it can become even more frustrating. Part of the intent behind the workers’ compensation system is to ensure that an employee has the financial support that he or she needs to obtain medical treatment for the work-related injury. As seasoned Boston work injury attorneys, we have handled a variety of workers’ compensation cases on behalf of injured workers throughout the region. Our team will fight zealously for you to ensure that you receive the fair treatment and outcome that you deserve.

A recent case explored a situation involving an employee who reportedly suffered a shoulder injury followed by a back injury while at work. The employee received benefits, but the insurer eventually raised issues including causation, that the employee had a pre-existing condition, and that his injury was not caused by a work-related condition. At the hearing to determine whether the employee was entitled to benefits, the employee requested payment for the reasonable cost of a shoulder surgery to address his shoulder condition.

The judge concluded that the employee had reached maximum improvement on his shoulder injury but that he was partially disabled as a result. The judge also awarded benefits for the back injury, finding it to be causally related to his job duties. Both parties appealed. The judge also noted that the employee had sought medical benefits in a general fashion.

On review, the employee contended that the judge erred in finding that there was no additional need for medical treatment for the employee’s shoulder injury. The appellate court reviewed the evidence in the record and agreed with the employee. One of the employee’s treating physicians wrote in a report that the employee would benefit from surgery, for example. The judge mistakenly confused reaching a medical end result with not needing additional treatment.

The court also agreed with the employer that the judge did not make an appropriate finding regarding the employee’s average weekly wage. The judge did not support his findings with information based on fact regarding how much the employee made on an average basis. The judge did not explain the methodology or math used to reach the figure in the order, which made it difficult for the reviewing court to assess whether the appropriate rules were applied. As a result, the appellate court reversed the order and remanded the case for additional findings.

If you were hurt while at work you may be entitled to workers’ compensation benefits and reimbursement for your medical expenses. Pulgini & Norton’s seasoned team of Boston work injury attorneys can assist you in investigating your claim, gathering evidence, and protecting your rights during the complex proceedings. We provide a free consultation so that you can understand the process and how we can help you. Contact us today at 781-843-2200 or contact us online to get started.

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